Zygomycosis in Italy: a Survey of FIMUA-ECMM (Federazione Italiana di Micopatologia Umana ed Animale and European Confederation of Medical Mycology)
Zygomycosis in Italy: a Survey of FIMUA-ECMM (Federazione Italiana di Micopatologia Umana ed Animale and European Confederation of Medical Mycology)
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DOI：
10.1179/joc.2009.21.3.322
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发表时间：
2009-06-01
影响因子：
1.8
通讯作者：
Viviani, M.
中科院分区：
文献类型：
--
作者：
Pagano, L.;Valentini, C. G.;Viviani, M.
这项研究的目的是分析在欧洲医学真菌联合会调查期间在意大利登记的接合霉菌病患者的临床和流行病学特征和治疗方法。这项前瞻性多中心研究是在2004年至2007年期间在49个意大利部门进行的。60例接合霉菌病患者，中位年龄59.5岁(1~87岁)，男性占70%。大多数病例为免疫功能低下的患者(42例，70%)，主要是血液系统恶性肿瘤(37例)。在非免疫缺陷(18例，30%)中，以穿透伤为主(7/18，39%)。最常见的感染部位是鼻窦(35%)伴/不伴中枢神经系统受累，单纯肺(25%)，皮肤(20%)，但有11例(18%)有播散。根据EORTC的诊断标准，46例(77%)患者确诊为合霉菌病，其中大部分患者是活体诊断(40/46例，87%)，其余14例(23%)诊断为可能。51例患者接受了抗真菌治疗，其中30例还进行了外科清创。最常用的抗真菌药物是两性霉素B脂质体(L-Amb)，44例患者中有36例(82%)对治疗有反应。总的归因死亡率为32%(19/60)，而使用L-AMB的患者死亡率降至18%(8/44)。接合菌病是一种罕见的侵袭性丝状真菌感染，病死率较高。这项研究表明这一趋势发生了逆转，与文献报道的相比，预后更好，死亡率显著降低。可能是新的广泛的、积极的诊断和治疗方法，如L-AMB和外科手术的使用，改善了这些患者的预后。
The aims of the study were to analyze the clinical and epidemiological characteristics and treatments for patients who developed zygomycosis enrolled in Italy during the European Confederation of Medical Mycology survey. This prospective multicenter study was performed between 2004 and 2007 at 49 Italian Departments. 60 cases of zygomycosis were enrolled: the median age was 59.5 years (range 1-87), with a prevalence of males (70%). The majority of cases were immunocompromised patients (42 cases, 70%), mainly hematological malignancies (37). Among non-immunocompromised (18 cases, 30%), the main category was represented by patients with penetrating trauma (7/18, 39%). The most common sites of infection were sinus (35%) with/without CNS involvement, lung alone (25%), skin (20%), but in 11 cases (18%) dissemination was observed. According to EORTC criteria, the diagnosis of zygomycosis was proven in 46 patients (77%) and in most of them it was made in vivo (40/46 patients, 87%); in the remaining 14 cases (23%) the diagnosis was probable. 51 patients received antifungal therapy and in 30 of them surgical debridement was also performed. The most commonly used antifungal drug was liposomal amphotericin B (L-AmB), administered in 44 patients: 36 of these patients (82%) responded to therapy. Altogether an attributable mortality rate of 32% (19/60) was registered, which was reduced to 18% in patients treated with L-AmB (8/44). Zygomycosis is a rare and aggressive filamentous fungal infection, still associated with it high mortality rate. This study indicates an inversion of this trend, with a better prognosis and significantly lower mortality than that reported in the literature. It is possible that new extensive, aggressive diagnostic and therapeutic procedures, such as the use of L-AmB and surgery, have improved the prognosis of these patients.